This study will measure the effect of vaccine administration by pharmacists on pneumococcal and influenza immunization rates among adults, which lag far behind childhood immunizations. Pharmacists may administer vaccines in 24 States, typically under standing orders from a physician. At least 1,000 pharmacists in 12 states are trained to immunize. Pharmacists in Washington State lead this trend, giving approximately 50,000 immunizations in 1997. This study will assess whether vaccine administration by pharmacists increases overall immunization delivery among adults or displaces people from being immunized by other providers. This will be a cohort study among adults patronizing a pharmacy chain in urban Washington (Group 1), where pharmacists currently administer vaccines, and in urban Oregon (Group 2), where pharmacists are not authorized to administer vaccines. For each pharmacy, the study population will consist of adults sampled at random from those identified through prescription records as highly likely to be in target populations recommended to receive pneumococcal and influenza vaccines. A mail and telephone survey will confirm eligibility for immunization, immunization status, locations where immunized, demographic and geographic characteristics, and attitudes and opinions about these vaccines. The five specific aims of this study are: (1) To compare pneumococcal immunization rates among vaccine-eligible adults between Groups 1 and 2. (2) To likewise compare influenza immunization rates. (3) To compare 1998 influenza immunization rates at physicians' offices to vaccine-eligible adults between groups. (4) To compare 1998 influenza immunization rates among vaccine-eligible clients between groups, restricting the comparison to those unvaccinated in 1997. (5) To identify the characteristics that predict which type of vaccine provider (e.g., physician, pharmacist, public-health clinic) people select in 1998. The findings will be applied to furthering the prevention of the fifth leading cause of death among the elderly in the U.S.